ABSTRACTS OF THE 21st ANNUAL MEETING OF THE ITALIAN ...

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Alba Fiorentino, Costanza Chiumento, Anna Maria Mileo, Mariella Cozzolino, Rocchina Caivano, Giorgia Califano, Stefania Clemente and Vincenzo Fusco IRCCS-CROB, Radioterapia Oncologica, Centro di Riferimento Oncologico di Basilicata, Rionero In Vulture, Potenza, Italy Aim: To evaluate biochemical disease-free survival (b-DFS) after low-dose rate 125 I permanent prostate brachytherapy implant (LDR-BRT) in patients with prostate cancer. Patients and Methods: Patients older than 18 years of age with diagnosis of prostate adenocarcinoma and adequate PSA follow-up time were analyzed in this retrospective study. LDR-BRT was performed as monotherapy, with a prostate total dose of 145 Gy. Patients were divided into recurrencerisk groups according to the criteria of the National Comprehensive Cancer Network. The guidelines of the American Society of Therapeutic Radiology and Oncology were used to define biochemical failure, which was calculated from the implantation date to the date of biochemical recurrence. Post-implant D90, defined as the minimum dose covering 90% of the prostate, was calculated for each patient. Univariate and multivariate statistical analyses were performed using SPSS software. For univariate analysis, cutoff points of 5.89 ng/ml for PSA and 5 for Gleason score (GS) were used. Clinical stage, pre-treatment PSA, GS, androgen deprivation therapy, D90 and risk groups were analyzed in the multivariate analysis. Results: From June 2003 to April 2007, 70 patients were treated and analyzed. Among them, 39 (56%) were at low risk, 23 (33%) at intermediate risk and the remaining 8 (11%) at high risk of recurrence. With a median follow-up time of 58 (range, 46- 92) months, the global 5-year b-DFS rate was 86%. In the low-, intermediate- and high-risk groups, the 5-year b-DFS rate was 97.2%, 82.6% and 62.5%, respectively (p=0.006). In univariate analysis, initial PSA level, GS and risk group were significant predictors of biochemical failure (p=0.01, 0.01 and 0.006, respectively, by log-rank test). In multivariate analysis, only risk group and GS (p=0.005 and 0.03, respectively) were statistically significant predictors of b- DFS. Discussion and Conclusion: Our data compared favorably with the literature (1, 2) and confirmed the advantage of LDR-BRT, especially for low- and intermediaterisk patients with early prostate cancer. 1 Merrick GS, Butler WM and Galbreath RW: Five-year biochemical outcome following permanent interstitial brachytherapy for clinical T1-T3 prostate cancer. Int J Radiat Oncol Biol Phys 51: 41-48, 2001. 2 Potters L, Cha C and Oshinsky G: Risk profiles to predict PSA relapse-free survival for patients undergoing permanent prostate brachytherapy. Cancer J Sci Am 5: 301-306, 1999. 1858 ANTICANCER RESEARCH 31: 1807-1956 (2011) 92 ADDED VALUE OF MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING IN PATIENTS WITH NEGATIVE ULTRASOUND-GUIDED PROSTATE BIOPSY Andrea Fandella1 , Francesco Di Toma2 and Bernardino Spaliviero2 1Unità di Urologia and 2Unità di Scienza delle Immagini, Casa di Cura Giovanni XXIII, Monastier di Treviso, TV, Italy Aim: To prospectively investigate the incremental value of multiparametric magnetic resonance (MR) imaging compared with standard T 2-weighted imaging for biopsy planning. Patients and Methods: A total of 43 consecutive patients underwent T 2-weighted MR imaging supplemented with multiparametric 1.5-T MR imaging, consisting of proton ( 1 H) MR spectroscopy, diffusion-weighted (DW) imaging and dynamic contrast-enhanced (DCE) MR imaging. From the multiparametric MR imaging, quantitative maps of the following parameters were calculated: choline plus creatine to citrate ratio, apparent diffusion coefficient, and volume-transfer and exchange-rate constants. The prostate was divided into 20 standardized areas. Each area was classified as benign, inconclusive, or suspicious at T 2-weighted imaging, followed by quantitative evaluation of all inconclusive and suspicious areas with MR parameter maps. Transrectal ultrasound (TRUS) biopsy, guided by the MR findings, was performed for lesions classified as suspicious for cancer using at least one of the MR parameter maps after being overlain on the T 2-weighted images, and displayed in three dimensions. Diagnostic parameters were calculated on a per-lesion and per-patient basis for all combinations of T2-weighted images with MR parameter maps. Results: A total of 43 patients had a median of two prior TRUS biopsies with negative findings. Each patient had a median count of three suspicious lesions. Prostate cancer was demonstrated in 21 of 43 patients. Biopsy was performed for 128 lesions; 53 of them were positive for prostate cancer. Digital rectal examination was not suspicious for malignancy in 40 patients, while it indicated malignancy in only 3 cases. The biopsy Gleason score (GS) within this group was distributed as follows: 52% GS≤6, 33% GS=7, 14% GS≥8. Conclusion: Only the combination of T 2-weighted imaging with all three MR multiparametric techniques depicted all identifiable prostate carcinomas. The combination of T2-weighted imaging with only two MR multiparametric techniques (DW imaging and 1H MR spectroscopy or DW imaging and DCE MR imaging) missed 6%, reasonably reducing the number of areas needing biopsy.
Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy 94 ePTFE INFERIOR VENA CAVA PATCH RECONSTRUCTION SURGERY IN DELAYED CAVAL THROMBECTOMY IN A MALE PATIENT WITH PREVIOUS RADICAL NEPHRECTOMY DUE TO RIGHT KIDNEY TUMOR Antonio Cisternino1 , Giovanni Paroni2 , Ercole Beccia1 , Michele Morcaldi1 , Pasquale Setola1 , Domenico Di Noia1 and Giuseppe Creti1 1Urologia and 2Chirurgia Vascolare, IRCCS-Casa Sollievo Della Sofferenza-Opera Padre Pio, San Giovanni Rotondo, Foggia, Italy Background: Abdominal full vena cava thrombosis, abandoned after right radical nephrectomy, is very rare. We describe the complex surgical technique in a 38-year-old male patient with a full thrombus of the vena cava remaining after right radical nephrectomy. Case Report: A 38-year-old male with symptomatic abdominal pain was referred to our hospital one month after right radical nephrectomy due to kidney tumor. A CT scan prior to nephrectomy showed an 8-cm right renal mass with extended thrombosis in the inferior vena cava (IVC) until the iliac cross. No other abdominal mass had been previously described. The patient underwent right radical nephrectomy with abdominal Mercedes incision without caval surgery for thrombectomy. After the operation, the patient was referred to the oncologist for adjuvant therapy. The oncologist referred the patient back to the Urology Department for reconsideration of caval surgery. Xipho-pubic surgical abdominal incision was carried out with severe sub-hepatic abdominal viscerolysis of the ileum, right and transverse colon that occupied the previous right retroperitineal kidney space. An urovascular approach was adopted with a double team. It was impossible to perform the usual incision in the root of the mesentery and Kocker maneuver, allowing the dissection of the aorta and the sub-hepatic IVC, because of the previous surgery. After the approach to the aorta and vena cava, the intra-hepatic vena cava was completely exposed with hepatic rotation. The left renal vein was completely prepared from the IVC through the kidney. A clamp up to the sub-diaphragmatic vena cava was placed; the hepatic vascular support was also prepared and clamped. Subsequently, we proceeded with incision of the IVC until the iliac bifurcation and the extended cavo-iliac thrombus was removed. In the ligated hilum cross of the right kidney vascular support, the thrombus was fixed to the wall of the vena cava and extended for several centimeters. Consequently, a large part of the IVC was removed together with the thrombus. Regular suturing of caval tissue was impossible. Subsequently, polytetraethylene expanded (ePTFE) material was tailored for a reconstruction patch in the vena cava. The ePTFE was much more useful than Dacron material. Results: Total operation time was 3.5 h, with a blood loss of 700 ml and use of two transfusion units. No postoperative complication appeared and the patient was discharged in ten days. The 10-month outcome is excellent and the patient is metastasis-free. Conclusion: The multidisciplinary urovascular approach taken in this case is the gold standard, considering the possible outcome indicated by the kidney tumor pathology when the surgery is well done. A one-stage surgery, namely radical nephrectomy and the simultaneous removal of the thrombotic material, should always be considered in order to reduce early embolism phenomenon and early metastasis. Because of high perioperative mortality, it is strongly suggested these cases are referred to the surgical urovascular teams, which are familiar with such surgical procedures. 95 PRELIMINARY STUDY OF THE EFFECTS OF GEFITINIB, AN EGF-RECEPTOR INHIBITOR, ON PROSTATE CANCER STEM CELLS Andrea Fandella1 , Mara Tommasini2 , Paolo Parnigotto2 and Sargio De Angeli3 1Unità di Urologia - Casa di Cura Giovanni XXIII, Monastier di Treviso, TV, Italy; 2Dipartimento di Scienze Farmaceutiche - Università degli studi di Padova, Padova, Italy; 3Servizio di Immunoematologia e di Medicina Trasfusionale Ospedale di Treviso, ULSS9, TV, Italy Background: Existing therapies for prostate cancer eradicate the bulk of cells within a tumor, but most patients go on to develop androgen-independent disease that remains incurable by current treatments. The progression of the disease seems to be caused by a small population of cells, named cancer stem cells, which show stem cell features: they are self-renewing, can differentiate and are highly tumorigenic in vivo. Using neurosphere culture strategies, unattached clusters of cells (prostaspheres) with cancer stem cell properties can be obtained from both malignant and non-malignant prostate tissues. The culture of prostaspheres is useful to obtain a consistent number of cancer stem cells and allows their propagation in an undifferentiated state. The epidermal growth factor receptor (EGFR) and its ligands (EGF, TGF-α) are overexpressed during the progression of benign, localized and metastatic forms of prostatic cancer. The up-regulated activation of EGFR signaling appears to sustain cell proliferation, vascularization, invasion and decrease of cell apoptosis. It has also been reported that the interruption of EGF–EGFR signaling by using a selective EGFR inhibitor, such as gefitinib, leads to growth inhibition and apoptotic death of many cancer cell types, including prostate tumor epithelial cells, both in vitro and in vivo. Moreover, gefitinib, combined 1859
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